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Gastro-intestinal and respiratory diagnostic and therapeutic procedures.
- Address: Maidstone and Tunbridge Wells hospitals,
- What we do
- Our team
- Get in touch
- Bronchoscopy
- Capsule endoscopy
- Colonoscopy
- Endoscopic retrograde cholangio-pancreatography (ERCP)
- Endoscopic ultrasound scan
- Flexible sigmoidoscopy
- Gastroscopy
- Polypectomy
- Kent and Medway Endoscopy Training Hub
What we do
Endoscopy is a test to look inside the body using a small camera, often at the end of a long tube. The camera is passed into the body through an opening such as the mouth.
Our Endoscopy team perform a wide range of gastro-intestinal and respiratory procedures for inpatients and outpatients, using state-of-the-art equipment. The team perform around 18,500 procedures each year and are national leaders on the Bowel Cancer and Bowel Scope Screening programmes.
We are the only trust in Kent and Medway taking part in a pilot programme where patients swallow a tiny camera known as colon capsule endoscopy (CCE), and are the Endoscopy Training Hub for Kent and Medway.
Both our units are JAG (Joint Advisory Group)-accredited, ensuring a high-quality, safe and appropriate endoscopy service, delivered by a highly-trained team. We also have JAG training provider accreditation status and are one of the national centres commissioned to improve endoscopy training in England.
The team are involved in a number of research projects and aim to ensure our practice is based on the best available clinical evidence to provide the highest standard of care for every patient.
Our philosophy of care
Our philosophy is to provide a safe and high standard of care throughout the endoscopy process. High standards of care come from individual skills in a multidisciplinary team encompassing the rights and needs of each patient regardless of race, colour or creed.
Essential to our philosophy is a high standard of communication in our team, to provide safe care for the patient.
Standard performance of the endoscopy service will be monitored using “The Globe Rating Score” as recommended by the JAG with reference to regulations from the Medical Defence Union and the Royal College of Nursing.
Our aim is to ensure our clinical practice is based on up-to-date information to safeguard a high standard of care for every patient. This is supported by regular training updates for all clinical staff and evidenced by audit results.
The team ensure the units are maintained as a pleasant working environment, all staff have up-to-date training records and regularly take part in multidisciplinary team meetings. This is supported by regular clinical governance meetings, staff meetings and endoscopy user group meetings. Every member of staff has an annual appraisal and a personal development plan to support their career in endoscopy.
Our team
30-35 physicians, surgeons and nurse endoscopists supported by nurses deliver endoscopy at our hospitals. They are supported by a large team of specialist nurses, endoscopy assistants and technical staff.
- Debora Primerano, Deputy General Manager for General Surgery and Endoscopy and Kent and Medway Training Hub Manager
- Raquel Souto, Endoscopy Practice Educator
- Ezzy Chandler, Endoscopy Service Manager
Medicine
- Dr Adrian Barnardo, Consultant Gastroenterologist, Endoscopy Lead, Kent and Medway Endoscopy Training Hub lead
- Dr Bijay Baburajan, Consultant Gastroenterologist and Endoscopist, Endoscopy Training Lead
- Dr Iona Bell, Consultant Gastroenterologist and Endoscopist
- Dr Paul Blaker, Consultant Gastroenterologist and Endoscopist
- Dr Justin Fegredo, Consultant Gastroenterologist and Endoscopist
- Dr Doddi Hanumantharaya, Consultant Gastroenterologist and Endoscopist
- Dr Laurence Maiden, General Physician and Gastroenterologist, and Endoscopist
- Dr Hermant Sharma, Consultant Gastroenterologist and Endoscopist.
Surgery
- Miss Helen Lloyd, Surgical Clinical Lead for Endoscopy, Consultant General Surgeon and Endoscopist
- Mr Yasser Abdulaal, Emergency Surgery Consultant and Endoscopist
- Mr Charles Bailey, Consultant General Surgeon and Endoscopist
- Mr Dinesh Balasubramanian, Emergency Consultant and Endoscopist
- Mr Ahmed Hamouda, Consultant General Surgeon and Endoscopist
- Mr Jordan Iordanov, Surgical Associate Specialist and Endoscopist
- Mr Rasa Moosvi, Consultant General Surgeon and Endoscopist
- Mr Mahir Shahabdeen, Surgical Associate Specialist and Endoscopist
- Miss K Takacs, Staff Grade Surgical Doctor and Endoscopist
- Mr Gabor Toth, Staff Grade Surgical Doctor and Endoscopist
- Mr Christopher Wright, Consultant General Surgeon and Endoscopist.
Respiratory
- Dr Simon Webster, Chief of Service for Medicine and Emergency Care, Lead Respiratory Consultant, Respiratory Consultant and Endoscopist
- Dr Phillip Davidson, Respiratory Consultant and Endoscopist
- Dr Terry Lim How, Respiratory Consultant and Endoscopist
- Dr Ravish Mankragod, Respiratory Consultant and Endoscopist
- Dr Tuck-Kay Loke, Respiratory Consultant and Endoscopist.
Clinical endoscopists
- Ricardo Alves, Lead Clinical Endoscopist
- Monica Silva, Lead Clinical Endoscopist
- Guilherme Pereira, Senior Clinical Endoscopist
- Steven Ablos, Clinical Endoscopist
- Mark Canoy, Clinical Endoscopist
- Leona Chibambo, Clinical Endoscopist
- Christine Herrera, Clinical Endoscopist
- Febie Ladroma, Clinical Endoscopist
- Augustina Simpson, Clinical Endoscopist.
Endoscopic ultrasound
- Mr Jeffrey Lordan, Emergency, UGI Consultant Surgeon and Endoscopic Ultrasound Endoscopy Lead
- Dr Doddi Hanumantharaya, Consultant Gastroenterologist and Endoscopist.
Bowel cancer screening
- Dr Adrian Barnardo, Endoscopy Lead, Kent and Medway Endoscopy Training Hub Lead, Consultant Gastroenterologist
- Dr Laurence Maiden, General Physician and Gastroenterologist, and Endoscopist
- Mr Dinesh Balasubramanian, Emergency Consultant and Endoscopist
- Mr Jordan Iordanov, Surgical Associate Specialist and Endoscopist
- Mr Sanjay Joshi, Surgical Associate Specialist and Endoscopist
- Mr Ricardo Alves, Lead Nurse Endoscopist.
Endoscopic Retrograde Cholangio-Pancreatography (ERCP)
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Dr Hermant Sharma, Clinical Lead for Endoscopy, Consultant Gastroenterologist and Endoscopist
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Dr Doddi Hanumantharaya, Consultant Gastroenterologist and Endoscopist
Get in touch
The Endoscopy day units at Maidstone and Tunbridge Wells hospitals perform a range of gastro-intestinal diagnostic and therapeutic procedures.
The Maidstone Hospital Endoscopy Unit is in the yellow zone on the ground floor. The Endoscopy Unit at Tunbridge Wells Hospital is in the purple area on Level -1.
Maidstone Hospital
Unit Manager: Sally Nicholas/Hema Kafle
Telephone number: 01892 638210
Tunbridge Wells Hospital
Unit Manager: Sally Craven
Telephone: 01892 638210
General queries about appointments: 01892 638210
- Option 1: to change or cancel an appointment at Tunbridge Wells or Maidstone (lines are open Monday - Friday, 9.00-11.00am and 1.30-3.30pm)
- Option 2: medical enquiry with appointment at Tunbridge Wells
- Option 3: medical enquiry with appointment at Maidstone.
Opening hours
Both units are open 8am to 6.30pm Monday to Friday, 8am to 5pm on Saturdays. The unit at Tunbridge Wells Hospital is open 8am to 1pm on Sundays.
The unit at Maidstone Hospital is temporarily open on Sundays 8am to 6.30pm.
For our visitor policy, information about protected meal times and infection control on our wards, see the visiting hours page.
Bronchoscopy
What is bronchoscopy?
A bronchoscopy is a test allowing the endoscopist to look directly into your large airways (trachea and bronchi). These are the main tubes that carry air into your lungs.
A fibreoptic bronchoscope, thin as a pencil, flexible telescope is passed through your nose or throat, into your wind pipe (trachea), and down into your bronchi. The bronchoscopy usually takes about 20-30 minutes.
What else may be done during the procedure?
The endoscopist may take one or more samples (biopsies) of parts of the inside lining of the airways (depending on why the test is done and what they see). This is painless.
The samples are sent to the laboratory for testing and to be looked under the microscope.
Sometimes bronchial lavage is done. This is a procedure where some fluid is squirted into a section of the lung and then suctioned back. The fluid is then examined in the laboratory to look for abnormal cells and other particles that may be present in certain diseases.
Preparation
To prevent vomiting or aspiration, the stomach must be empty. You will be asked not to have anything to eat or drink for at least six hours before the test.
When you come to the department, a doctor or nurse will explain the test to you and will usually ask you to sign a consent form. This is to ensure that you understand the test and its implications.
Please tell the doctor or nurse if you have had any allergies or bad reactions to drugs or other tests. They will also want to know about any previous endoscopy you have had.
If you have any worries or questions at this stage, don’t be afraid to ask, the staff will want you to be as relaxed as possible for the test and will not mind answering your queries.
During the procedure
In the examination room you will be made comfortable on a bed, resting on your back. A nurse will stay with you throughout the test.
You will have a local anaesthetic in a form of spray on the back of your throat to numb it and an injection into your arm to make you feel sleepy and relaxed. If going through the mouth, to keep it slightly open, a plastic mouthpiece will be put gently between your teeth.
When the endoscopist passes the bronchoscope into your airway, you should expect some coughing but you will still be able to breathe at all times. If you get a lot of saliva in your mouth, the nurse will clear it using a sucker. When the examination is finished, the bronchoscope is removed quickly and easily.
After the procedure
You will be left to rest in the unit for at least thirty minutes. As you have had your throat numbed by a spray, you will have to wait until your swallowing reflex is back to normal – this usually takes no more than an hour.
After this, you can eat and drink normally. The back of your throat may feel sore for the rest of the day.
What to expect after bronchoscopy
It is essential a responsible adult comes to pick you up and remains with you for 12 hours. Once home, it is important to rest quietly for the remainder of the day.
After a bronchoscopy there are minimal side effects, but you should be aware of the following:
- Food and drink: alcohol in combination with sedation you may have received is likely to make you much more sleepy than usual. Due to the local anaesthetic used in your throat, you should not eat or drink until normal sensation returns, usually within an hour of the procedure. Normal food can be taken after the examination, though you may prefer light meals on the day of the examination.
- Pain: A mildly sore throat and nose is no cause for concern and should resolve within 48 hours. If you are troubled by more than this, please consult your own GP or contact the Department.
- Activities: If you have been given sedation during the procedure it will make you less alert than usual and you should therefore not drive or make any decisions for the rest of the day. You may resume normal activities on the day after the examination.
- Medications: you may be asked not to take anti-coagulation medication but will be able to resume normal medications immediately after the bronchoscopy. Please ask if you are not sure that a medication is safe.
Things to report to your doctor:
- Severe pain or vomiting
- Temperature greater than 38 degrees
- Redness, tenderness and swelling at the site of the intravenous injection that persists
If you have any worries please contact the Endoscopy Department, your GP or go to your nearest A&E (taking a copy of the endoscopy report with you).
When will I know the results?
In most cases the endoscopist will be able to tell you the results as soon as you are awake, and you will receive a copy of the report to take home.
However, if a sample (biopsy) has been taken for examination, the results may take a few weeks. It is a good idea to have someone with you when you speak to the nurse after the test since people often find they forget things that are said to them and many do not recollect having the test at all after sedation.
Further details of the results and any necessary treatment can be discussed with your GP or hospital specialist – whoever recommended you to have the test.
Capsule endoscopy
What is a capsule endoscopy?
Capsule endoscopy helps us diagnose gastrointestinal conditions affecting the small bowel, such as obscure gastrointestinal bleeding, malabsorption, chronic abdominal pain and chronic diarrhoea.
It involves swallowing a small (the size of a large vitamin pill) capsule, which contains a colour video camera, battery, light source and transmitter.
The camera takes lots of pictures as it travels along your gut. The camera sends the pictures to a data recorder you wear on your waist.
Once swallowed, the camera moves naturally through the digestive tract while patients carry out their normal activities.
Approximately eight hours after ingesting the camera, patients return the recording device to the nurse so the images can be downloaded to a computer and evaluated. The video capsule endoscope is disposable and will be excreted naturally in your bowel movement.
On the day
- Arrive in the Unit
- Admission and placement of sensor array and data recorder
- Capsule swallowed with small amount of water
- Two hours after ingestion of capsule clear fluids can be started
- A light snack may then be eaten approximately four hours after swallowing the capsule
- Eight hours after the swallowing the capsule a normal diet may be resumed
Colonoscopy
What is a colonoscopy?
Colonoscopy is a test allowing the endoscopist to look at the lining of the large intestine (the colon). Diagnostic colonoscopy is recommended for persistent change in bowel habits, or blood in the stool (which may be visible or invisible), unexplained anaemia and as a screening test for colon cancer.
To do the test a colonoscope is carefully passed through the anus into the rectum and through the intestine. The colonoscope is a long flexible tube, about the thickness of your index finger, with a bright light and video camera at its tip.
Images of the inside of the colon are shown on a monitor, allowing the endoscopist to examine the lining of the colon for any disease or abnormalities.
What else may be done during the procedure?
During the colonoscopy a biopsy (a sample of the lining of the bowel for closer examination under the microscope) may be taken using tiny biopsy forceps. This is a painless procedure.
It is also possible to remove polyps during a colonoscopy. These are abnormal projections or growths of tissue from the lining of the bowel, rather like a wart, and certain types of bowel polyps may be at risk of developing into cancer if left.
If polyps are found, the endoscopist may decide to remove them during the procedure; again this is painless. Occasionally it may be necessary to return for a repeat colonoscopy to treat large or difficult to remove polyps.
Bowel preparation
To allow a clear view, the colon must be clean and completely empty of waste material. If it is not, areas may be obscured and the test may have to be abandoned and repeated at a later date.
It is important to take all the laxatives prescribed and considerably increase your intake of clear fluids on the day before the examination, which will help clean the bowel.
Please also follow the dietary instructions for the few days before the test, as this will help ensure the bowel is clean.
You will be given detailed information and instructions on how to take the laxatives.
When you come to the department, we will explain the test to you and ask you to sign a consent form. This is to ensure that you understand the test and any potential complications.
Please tell the doctor or nurse if you have had any allergies or bad reactions to drugs or other tests in the past.
They will also want to know about any previous endoscopy you have had, or any other medical conditions you suffer from and medication which you may be taking. If you have any worries or questions, don't be afraid to ask. We want you to be as relaxed as possible for the test and will not mind answering your queries.
During the procedure
You will be placed in a comfortable position on your left side, and may be given medication by injection through a vein to make you sleepy and relaxed.
The endoscopist will then pass the colonoscope into the rectum, and through the colon.
Colonoscopy is not usually painful but you may experience some abdominal cramping and pressure from the air (carbon dioxide) introduced into your bowel; this is normal and will pass quickly. You may also be asked to change position during the examination, and will be assisted by a nurse. The examination usually takes anywhere from 15 to 60 minutes.
After the procedure
You will be left to rest in the recovery area for around an hour, until the main effects of any medication wear off.
After your colonoscopy, a responsible adult must collect you, as you will be drowsy from the medication you have been given. You must not drive a vehicle, drink alcohol, operate machinery or make any important decisions until the day following your discharge.
This is because it takes some time for the medication to work its way through your system. You may resume your normal daily activities the day after the examination.
The doctor or nurse will have told you before being discharged if you had biopsies taken or polyps removed. If this was the case, you may notice traces of blood coming from your back passage.
If bleeding persists, becomes more severe or the abdominal pain becomes worse, you should contact either the Endoscopy Unit, your GP or go to your nearest A&E (taking the copy of your endoscopy report with you).
- Food and drink: Alcohol in combination with any sedation you may have received is likely to make you much more sleepy than usual. Normal food can be taken after the examination, though you may prefer light meals on the day of the examination.
- Medications: You may resume normal medications immediately after your colonoscopy but if a polyp was removed we may advise against taking certain blood-thinning or anti-inflammatory drugs for a defined period. Please ask if you are not sure a medication will be safe. You may take stool softeners and bran but do not take strong laxatives.
- Bowel actions: Your colon has been completely emptied and you should not expect necessarily to start to have normal bowel function for two to three days. Bowel actions after that should rapidly return to normal.
Things to report to your doctor:
- Severe pain or vomiting
- Passage or vomiting of blood
- Temperature greater than 38 degrees
- Redness, tenderness and swelling at the site of the intravenous injection that persists.
If you have any worries please contact the Endoscopy Department, your own GP or go to A&E (taking the copy of your endoscopy report with you).
When will I know the results?
In most cases, a member of staff will be able to tell you the results of the test as soon as you are awake and you will be given a copy of the endoscopy report to take home.
However, if a biopsy sample or polyp was removed for microscopic examination, these results may take up to two weeks to process.
Many patients find sedation tends to make them forget any explanations given to them after the procedure. Details of any results or further investigations may be obtained from your GP or specialist (whoever referred you for the test), and will usually be detailed on your copy of the endoscopy report.
Endoscopic retrograde cholangio-pancreatography (ERCP)
What is ERCP?
An ERCP (endoscopic retrograde cholangio-pancreatography) procedure allows the endoscopist to take detailed X-rays of the bile duct and/or pancreas. You will lie on an X-ray table and the doctor will explain what will happen.
Your throat will be numbed with a special spray and you will be given an injection which will make you very sleepy. Once you are sleepy, an endoscope (a long, thin flexible tube with a bright light and video camera at one end) will be passed through your mouth, down into your stomach and the upper part of the small intestine (the duodenum).
X-ray dye will be injected down the endoscope so that the pancreas and bile ducts may be seen on X-ray films. If everything is normal, the endoscope is then removed and the test is complete. The dye is passed out of your body harmlessly.
What else may be done during the procedure?
If the X-rays show a gallstone, the doctor will enlarge the opening of the bile duct with an electrically heated wire (diathermy) which you will not feel. Any stones will be removed and left to pass into the intestine. If a narrowing or other abnormality is found the endoscopist may take a sample of cells from the duct (known as ‘brushings’) to send for further analysis.
Occasionally, if a blockage is found, a short tube may be placed in the bile or pancreatic duct, to enable drainage. You will not be aware of the tube, which may remain in place permanently or be removed at a later date.
Before the procedure
To allow a clear view, the stomach and duodenum must be empty. You will be asked not to have anything to eat or drink for at least six hours before the procedure.
When you come to the department, the procedure will be explained and a doctor will ask you to sign a consent form to ensure you understand the test and any potential complications. Please tell the nurse or doctor if you have had any previous endoscopic examinations, or reactions to drugs or allergies.
In some situations, antibiotics are given by injection before the procedure.
If you have any worries or questions at this stage don't be afraid to ask; we want you to be as relaxed as possible for the test and do not mind answering questions.
You may be asked to take off your shirt or jumper and put on a hospital gown. You will also need to remove any false teeth or contact lenses. Jewellery or metal objects should also be removed because they interfere with X-rays and a special instrument called a diathermy. They will be kept safely until after the examination.
After the procedure
When you return to recovery, you will feel sleepy. The nurse will advise you when you can eat and drink. The results of the test and any treatment given will be explained and you should be allowed to leave the same day, but sometimes it is necessary to stay overnight and be discharged the next morning.
What to expect after ERCP
If you are having an ERCP without any additional treatment it is likely you will be allowed home after the test, but it is essential someone comes to collect you. Once home, it is important to rest quietly for the remainder of the day.
Sedation given during the procedure will make you less alert and sleepy. Do not make any major decisions or sign any legal documents on the day. Do not drive for 24 hours after the procedure or drink alcohol, and avoid any strenuous exercise for 48 hours. You may resume all other activities on the day of the procedure.
- Food and drink: It is advisable to avoid large or rich meals for the day following your procedure and some people prefer to take fluids only for the first 4-6 hours after the test before eating.
- Pain: A mildly sore throat is not unusual and should resolve within 24 hours. It is not uncommon to experience some discomfort immediately following the procedure due to air in the stomach, this is usually mild and will soon pass. Very rarely you may have more severe abdominal pain, sickness and a temperature due to inflammation of the pancreas. This is called pancreatitis and it is unlikely that this will happen. If your procedure is being performed as a day case and pain develops later, consult your own doctor, contact the Endoscopy Unit or go to A&E (taking a copy of the ERCP report with you).
- Medications: You may resume normal medications immediately after your ERCP, however we may advise against taking certain blood-thinning or anti-inflammatory drugs for a defined period. Please ask if you are not sure if your medication will be safe to take with the sedation.
Things to report to your doctor
- Severe pain or vomiting
- Passage or vomiting of blood
- Temperature greater than 38 degrees
If you have any worries please do not hesitate to contact either the Endoscopy Department, your own GP or go to A&E (taking a copy of the ERCP report with you).
What are the risks and complications?
Fortunately, these procedures are safe and complications are rare. Potential serious complications include bleeding, perforation (making a hole in the lining of the GI tract), infection and pancreatitis (inflammation of the pancreas). If you have any problems after ERCP which you feel may be related to the test, please inform us at once.
An operation may be necessary to treat a complication, but this is very rare. Again, please do not hesitate to discuss possible complications or risks with the endoscopist.
Endoscopic ultrasound scan
An EUS (endoscopic ultrasound scan) allows the endoscopist to look clearly at your oesophagus (gullet), stomach, pancreas and bile ducts.
The scan uses high frequency sound waves transmitted through the tip of an endoscope (a flexible tube with a small camera at the tip).
The endoscope is passed down the oesophagus and into the stomach and duodenum. A scan of the surrounding structures can then be carried out. EUS is very accurate, which may identify information which cannot be seen on conventional scans. This test usually takes about 30 – 40 minutes.
What else may be done during the procedure?
A small tissue sample (known as fine needle aspiration) can be taken through the endoscope. This will be painless.
Before the procedure
To allow a clear view, the stomach and duodenum must be empty. You will be asked not to have anything to eat or drink for at least six hours before the procedure.
When you come to the department, the procedure will be explained and a doctor will ask you to sign a consent form to ensure you understand the test and any potential complications. Please tell the nurse or doctor if you have had any previous endoscopic examinations, or reactions to drugs or allergies.
If you have any worries or questions at this stage don't be afraid to ask, we want you to be as relaxed as possible and will not mind answering your queries.
You may be asked to take off your shirt or jumper and to put on a hospital gown. You'll need to remove false teeth or contact lenses. Jewellery or metal objects should also be removed; they will be kept safely until after the examination.
After the procedure
When you return to recovery, you will feel sleepy. The nurse will advise you when you can eat and drink. The results of the test and any treatment given will be explained and you should be allowed to leave the same day. It is essential a responsible adult comes to collect you.
- Food and drink: Alcohol in combination with sedation is more likely to make you much more sleepy than usual. If local anaesthetic was used in your throat, you should not eat or drink until normal sensation returns, usually within an hour of the procedure. A mildly sore throat is no cause for concern and should resolve within 48 hours. Normal food can be taken after the examination, though you may prefer light meals on the day of the examination.
- Pain: A mildly sore throat is not unusual and should resolve within 24 hours. It is not uncommon to experience some discomfort immediately following the procedure due to air in the stomach, this is usually mild and will soon pass. If pain develops later, consult your own doctor, contact the Endoscopy Unit or go to the Accident & Emergency Department of your local hospital (taking a copy of the EUS report with you).
- Medications: You may resume normal medications immediately after your EUS, however we may advise against taking certain blood-thinning or anti-inflammatory drugs for a defined period. Please ask if you are not sure if your medication will be safe to take with the sedation.
Things to report to your doctor
- Severe pain or vomiting
- Passage or vomiting of blood
- Temperature greater than 38 degrees
If you have any worries contact the Endoscopy Department, your GP or go to A&E (taking a copy of the EUS report with you).
What are the risks and complications?
Fortunately, these procedures are safe and complications are rare. Potential serious complications include bleeding, perforation (making a hole in the lining of the GI tract) and infection. If you have any problems after the EUS which you feel may be related to the test, please inform us at once.
An operation may be necessary to treat a complication, but this is very rare. Please do not hesitate to discuss possible complications or risks with the endoscopist.
Flexible sigmoidoscopy
A flexible sigmoidoscopy is most commonly used to look for bleeding or non-cancerous growths, called polyps, in the colon and is one of the main screening tests for colorectal cancer.
It is a common outpatient procedure in which the inside of the lower part of the large intestine (also called the sigmoid or left colon) is examined with a flexible video endoscope.
What else may be done during the procedure?
During the sigmoidoscopy a biopsy (a sample of the lining of the bowel for closer examination under the microscope) may be taken using tiny biopsy forceps passed through the endoscope. This is a painless procedure.
It is also possible to remove small polyps during sigmoidoscopy. Polyps are abnormal projections or growths of tissue, rather like a wart, and certain types of bowel polyps may be at risk of developing into cancer if left.
If polyps are found the endoscopist may decide to remove them via polypectomy during the procedure, again this is painless. It may be necessary to return for a colonoscopy to examine the whole colon and treat any large or difficult to remove polyps.
Bowel preparation
When you come to the department, a member of staff will explain the test to you and will usually ask you to sign a consent form. This is to ensure you understand the test and its implications. Please tell the doctor or nurse if you have had any allergies or bad reactions to drugs or other tests.
They will also want to know about any previous endoscopy you have had, or any other medical conditions which you may suffer from and details of medication which you may be taking. If you have any worries or questions at this stage don't be afraid to ask; we will want you to be as relaxed as possible for the test and do not mind answering your queries.
Your rectum and lower bowels must be empty for the exam to be accurate and complete, but usually there are no diet or fluid restrictions before this procedure. To prepare the bowel for the procedure, you may have been given an enema to self-administer at home or if not, one will be administered shortly after you arrive in the department by one of the nursing staff. Try to hold the enema for at least five minutes before releasing it.
During the procedure
You will be placed in a comfortable position on your left side and the endoscopist will pass the sigmoidoscope into the rectum, and through the lower colon. You may experience some abdominal cramping and pressure from the air (carbon dioxide) which is introduced into your colon. This is normal and will pass quickly.
You may also be asked to change position during the examination, and will be assisted by a nurse. The procedure usually involves minimal discomfort and takes anywhere from 5 to 15 minutes. In most cases, sedatives and/or anaesthesia are not necessary.
After the procedure
You will usually be able to leave the endoscopy department very soon after the test, once you are changed and the results of the procedure have been explained.
You may continue to experience mild cramps or gas, but that passes quickly and you can resume normal activities and diet.
If you have had any biopsies taken or polyps removed, you may notice small traces of blood coming from your back passage. If this was the case you will have been told by the doctor or nurse caring for you before discharge.
If the bleeding persists, becomes more severe or the abdominal pain becomes worse, you should contact either the Endoscopy Unit, your GP or go to A&E (taking a copy of your endoscopy report).
You may resume normal medications immediately after your flexible sigmoidoscopy, but if a polyp was removed we may advise against taking certain blood-thinning or anti-inflammatory drugs for a defined period. Please ask if you are not sure that a medication will be safe. You may take stool softeners and bran but do not take strong laxatives.
Things to report to your doctor:
- Severe pain or vomiting
- Passage or vomiting of blood
- Temperature greater than 38 degrees
If you have any worries please do not hesitate to contact the Endoscopy Department, your own GP or go to A&E (taking a copy of your endoscopy report).
When will I know the results?
In most cases a member of staff will be able to tell you the results of the test and you will be given a copy of the endoscopy report to take home. However, if a biopsy sample or polyp was removed for microscopic examination these results may take up to two weeks to process.
Gastroscopy
What is a gastroscopy (OGD)?
Upper GI endoscopy, also called OGD (oesophago-gastro-duodenoscopy), gastroscopy or simply an 'endoscopy', is a test allowing the endoscopist to look directly at the lining of the oesophagus (the gullet), the stomach and around the first bend of the small intestine - the duodenum. In order to do the test, an endoscope is passed through your mouth into the stomach.
The endoscope is a thin flexible tube (no larger than a finger) with a bright light and video camera at the end. The endoscopist gets a clear view of the lining of the stomach and can check whether or not any disease is present. Sometimes the endoscopist takes a biopsy - a sample of tissue for analysis under the microscope in the laboratory, the tissue is removed painlessly through the endoscope using tiny forceps.
Preparation
To allow a clear view, the stomach must be empty. You will therefore be asked not to have anything to eat or drink for at least six hours before the test.
When you come to the department, a doctor or nurse will explain the test to you and will usually ask you to sign a consent form. This is to ensure you understand the test and its implications.
Please tell the doctor or nurse if you have had any allergies or bad reactions to drugs or other tests. They will also want to know about any previous endoscopy you have had. If you have any worries or questions at this stage don't be afraid to ask; we want you to be as relaxed as possible for the test and will not mind answering your queries.
During the procedure
In the examination room you will be made comfortable on a bed, resting on your left side. A nurse will stay with you throughout the test.
You will have the option of having a local anaesthetic in a form of spray on the back of your throat to numb it or you may have an injection into your arm to make you feel sleepy and relaxed. Many hospitals now find that the test can be done without any sedation as the endoscopes have become much smaller and easier to swallow. To keep your mouth slightly open, a plastic mouthpiece will be put gently between your teeth.
When the endoscopist passes the endoscope into your stomach it will not cause you any pain, nor will it interfere with your breathing at any time.
It may take up to fifteen minutes to examine all the areas of the oesophagus, stomach and duodenum carefully. During this time, some air will be passed down the endoscope to distend the stomach and allow a clearer view. The air is sucked out at the end of the test. If you get a lot of saliva in your mouth, the nurse will clear it using a sucker. When the examination is finished, the endoscope is removed quickly and easily.
After the procedure
You will be left to rest in the unit for at least thirty minutes. You will be given a drink but if you have had your throat numbed by a spray, you will have to wait until your swallowing reflex is back to normal - this usually takes no more than an hour. After this you can eat and drink normally.
The back of your throat may feel sore for the rest of the day. You may also feel a little bloated if some of the air has remained in your stomach. Both these discomforts will pass and need no medication.
If you only had throat spray, you can leave the hospital on your own and resume your normal routine. If you had sedation, it is essential a responsible adult comes to pick you up and remains with you up until 12 hours. Once home, it is important to rest quietly for the remainder of the day.
There are minimal side effects, but it is important you are aware of the following:
- Food and drink: Alcohol in combination with any sedation you may have received is more likely to make you much more sleepy that usual. If local anaesthetic was used in your throat, you should not eat or drink until normal sensation returns, usually within an hour of the procedure. A mildly sore throat is no cause for concern and should resolve within 48 hours. Normal food can be taken after the examination, though you may prefer light meals on the day of the examination.
- Pain: Abdominal pain is uncommon after gastroscopy. Some patients have discomfort due to wind in the stomach during the procedure but this subsides rapidly. If you are troubled by more than this, please consult your GP or contact the Department.
- Activities: If you have been given sedation during the procedure it will make you less alert than usual and you should not drive or make any decisions for the rest of the day. You may resume normal activities on the day after the examination.
- Medications: You may resume normal medications immediately after the gastroscopy. Please ask if you are not sure a medication is safe.
Things to report to your doctor
- Severe pain or vomiting
- Temperature greater than 38 degrees
- Redness, tenderness and swelling at the site of the intravenous injection that persists
If you have any worries please do not hesitate to contact the Endoscopy Department, your GP or go to A&E (taking a copy of the endoscopy report with you).
When will I know the results?
In most cases the endoscopist will be able to tell you the results straight after the test or, if you have been sedated, as soon as you are awake, and you will receive a copy of the endoscopy report to take home.
However, if a sample (biopsy) has been taken for examination the results may take a few weeks. It is a good idea to have someone with you when you speak to the nurse after the test since, if sedation has been used, people often find they forget everything that has been said to them and many do not recollect having the test at all.
Further details of the results and any necessary treatment can be discussed with your general practitioner or hospital specialist - whoever recommended you to have the test.
Polypectomy
Polyps are abnormal growths arising from the cells lining the bowel. 'Pedunculated' polyps are attached to the bowel wall with a stalk, and 'sessile' polyps have a broad base and protrude directly from the lining of the bowel.
Most polyps are benign but often have the potential to become malignant (cancerous) if left untreated.
What are the symptoms of polyps?
Most polyps produce no symptoms and often are found during endoscopy or imaging of the bowel. However some polyps can produce bleeding, mucosal discharge, alteration in bowel function or, occasionally, abdominal pain.
How are polyps diagnosed?
Diagnosis of colonic polyps is by colonoscopy, flexible sigmoidoscopy or CT-colonography (also known as ‘virtual colonoscopy’). Research has shown removal of polyps dramatically reduces the incidence of subsequent colon cancer.
What is polypectomy?
Polypectomy is the medical term for removing polyps. Small polyps can be removed with an instrument called biopsy forceps, which snip off small pieces of tissue.
Larger polyps are usually removed by putting a noose, or snare, around the polyp base and burning through the tissue with an electric current.
Neither of these procedures is painful and you will usually not be aware that they are being done.
Sometimes a polyp is too large to be removed by colonoscopy and needs surgery for removal. Polypectomy is very safe, but all procedures involve some risks, which you should discuss with your endoscopist. Potential serious complications of polypectomy include bleeding and perforation (creating a hole in the colon) but are rare.
Bleeding can usually be controlled by colonoscopy, when the bleeding site is cauterised, although surgery is sometimes required. Surgery is usually required for perforation. Other complications are possible but happen much less often.
You should follow your endoscopist’s instructions carefully following polypectomy; you may be advised to not take certain blood-thinning or anti-inflammatory drugs for a time after the polypectomy.
We will also tell you how to find out the results of the tissue analysis of your polyps and if a repeat examination will be needed.
Kent and Medway Endoscopy Training Hub
We are a training hub for Kent and Medway, under the South East Training Academy.
The training hub is a dynamic and innovative way of training people and boost the training of the next generation of endoscopists. Where it has taken five years to train endoscopists, the hub trains people to perform procedures in just six months. This is revolutionising endoscopy in the region and across the country.
As part of service expansion, the purchase of a state-of-the-art endoscopy virtual reality simulator is helping train clinical endoscopists in an immersive environment. This will help expand service capacity to treat patients from across Kent and Medway.
Providing expert training services to other trusts also increases the number of staff able to enter the workforce and expands endoscopy capacity across the region.
Statement from the South East Endoscopy Training Academy:
“Ensuring a continuous supply of well- trained medical professionals is a high priority if we are to have a functioning NHS. The endoscopy units at Maidstone and Tunbridge Wells are the Kent & Medway Hub Unit of the South East Endoscopy Academy. The Academy provides training for doctors, clinical endoscopists, nurses and members of the administrative team involved in endoscopy with programmes for new starters and senior members of staff learning additional skills.
There may be an Academy trainee involved in your care. It is important to understand that this will not reduce the standard of care that you can expect.
Your endoscopist may be described as a trainee clinical endoscopist or junior doctor. The phrase “junior doctor” is used for all doctors other than consultants. If you have a junior doctor performing your procedure, they will have been qualified for between five and fifteen years and have a wealth of medical experience. They will have demonstrated expertise at performing other complex invasive procedures before being allowed to learn endoscopy.
All our endoscopists are called “trainee” until they have undertaken each procedure at least 250 times and are able to perform it entirely unsupervised. You may have a trainee colonoscopist who already does other endoscopic examinations independently with a high level of skill.
All trainees are closely overseen by highly experienced clinicians with additional teaching qualifications. Their involvement will vary from minimal supervision to physical assistance with the procedure if they feel this to be necessary. The supervisor will be in the room at all times."
If you have any questions or feedback about training in endoscopy, please discuss them with the team looking after you or contact the Endoscopy Academy at endoscopyacademy.se@hee.nhs.uk.